Coronary artery vasculitis: a review of current literature

Abstract

Cardiac vasculitis is recognized as a heterogeneous disease process with a wide spectrum of manifestations including pericarditis, myocarditis, valvular heart disease and less frequently, coronary artery vasculitis (CAV). CAV encompasses an emerging field of diseases which differ from conventional atherosclerotic disease and have a proclivity for the younger population groups. CAV portends multiple complications including the development of coronary artery aneurysms, coronary stenotic lesions, and thrombosis, all which may result in acute coronary syndromes. There are several aetiologies for CAV; with Kawasaki’s disease, Takayasu's arteritis, Polyarteritis Nodosa, and Giant-Cell Arteritis more frequently described clinically, and in literature. There is a growing role for multi-modality imaging in assisting the diagnostic process; including transthoracic echocardiography, cardiac magnetic resonance imaging, computed tomography coronary angiography, fluorodeoxyglucose-positron emission tomography and conventional coronary angiogram with intravascular ultrasound. Whilst the treatment paradigms fundamentally vary between different aetiologies, there are overlaps with pharmacological regimes in immunosuppressive agents and anti-platelet therapies. Interventional and surgical management are is a consideration in select populations groups, within a multi-disciplinary context. Further large-scale studies are required to better appropriately outline management protocols in this niche population.

Acute Coronary Syndrome Developed in a 17-year-old Boy with Sitosterolemia Comorbid with Takayasu Arteritis: A Rare Case Report and Review of the Literature

“…The development of premature CAD has been reported in patients with sitosterolemia and in those with TA. Coronary stenosis in patients with TA is often located at the ostium or in the proximal segments of the coronary artery (7). However, the characteristics of the coronary lesions associated with sitosterolemia have not been fully elucidated.…”

“…Conversely, inflammation involving the elastic lamina of the arteries may result in an aneurysm (5,6). The most common manifestations of TA in the coronary arteries include stenosis or occlusion of the coronary ostia, diffuse or focal coronary arteritis, and coronary artery aneurysm, all of which can cause unexpected acute coronary (7).…”

Case Report: Acute Heart Failure Induced by the Combination of Takayasu's, Takotsubo and Coronary Vasospasm in an Elementary School Teacher–A Reaction to Return-to-Work Stress After COVID-19?

“…Cardiac manifestations include valvular abnormalities (mainly AR), myocardial abnormalities including HF or myocarditis, coronary artery disease, pericardial effusion or pericarditis, among other rarer presentations ( 4 ). The frequency of coronary artery involvement in TA is 10–30% and the three most common lesions are stenosis or occlusion of the coronary ostia (60–80%), diffuse disease that may involve all epicardial branches or only focal segments (10–20%) and coronary aneurysms (0–5%) ( 5 , 6 ). However, TA patients can also present with typical angina with normal coronary arteries, secondary to diastolic hypotension and reduced coronary blood flow ( 7 ).…”

Evolving Chest Pain in a Young Male Patient

“…Inflammation or thickening of the vessel wall is more suggestive of vasculitis, although conventional angiography is limited in the ability to evaluate the arterial walls (69). Multimodality imaging of coronary arteries with CT or MR angiography and cardiac MRI allows for high‐resolution visualization of the vessel walls and are key in the evaluation of coronary vasculitis (74).…”

“…Circumferential increase in metabolic activity within the coronary arteries is suggestive of vasculitis and may be present prior to the structural vessel changes detected by noninvasive angiography. However, it is difficult to distinguish vasculitis from atherosclerotic disease by PET imaging alone, which is a limiting factor in its utility for the evaluation of coronary vasculitis (74).…”